Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 4301041738 | MI |
NPI | 1811001407 |
---|---|
Provider Name | Dr. Michael Lawrence Netzloff |
First Address | East Lansing, MI 48824 |
Second Address | Lansing, MI 48912-1800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 15/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1320793 | (05) | MI |
A78142 | (02) | MI |